UWI After-School Care Centre

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Application Form

Please complete the application form below. Spaces are limited so apply now! You will be contacted by someone from the UWI After School Care Centre once your application is successful.

Child / Applicant Information
Child's Name	*
Date of Birth	*
Nickname

Parent / Guardian Information
Applicant Email Address - This will be used to send a confirmation email of your application.
Email

Mother or Guardian Name
ID Number		Cell Phone
Home Phone
Address
City
Occupation
Employer Name
Employer Address
City
Work Hours
	check if same as above address
Father or Guardian Name
ID Number		Cell Phone
Home Phone
Address
City
Occupation
Employer Name
Employer Address
City
Work Hours

Parents are
Parent/Guardian with legal custody

Emergency Contacts (other than Parents or Guardian)
Primary Emergency Contact	*
Relationship to Child
Home Phone		Work Phone
Address

Secondary Emergency Contact	*
Relationship to Child
Home Phone		Work Phone
Address
		* required field

Cocoa Research Unit

Application Form